Nursing Your Older Baby and Weaning

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For many women, weaning their breastfed infant represents the first among a host of developmental transitions that characterize childhood. The long journey involved in transforming a totally dependent newborn into a fully responsible, contributing adult is charted by a progressive series of transitional milestones, including weaning, becoming toilet-trained, starting kindergarten, entering puberty, or going off to college. It is our job as parents to serve as guides to see our child safely through the course, helping her at each junction to let go of old, familiar patterns and embrace new opportunities. In some instances, when circumstances mag-nify the sense of loss about what is being given up, negotiating life transitions can be uncomfortable, even painful, for both parents and children. On the other hand, when parents and children successfully move from one milestone to another with a sense of accomplishment and expectation, they emerge better equipped to navigate the next transition in a satisfying manner. For more than half of all infants in the United States, the process of weaning from the breast is one of their first significant transitions, making the topic worthy of an in-depth discussion.

What Is Weaning? Few terms convey such broad connotations as the diverse meanings that can be expressed by the word "weaning." A single word hardly seems adequate to describe all of the following: breastfeeding that could stop at either three weeks or three years; the prolonged, gradual discontinuation of nursing and the abrupt termination of breastfeeding; a process that is initiated by the mother's desires and one that is guided by the baby's needs. Obviously, weaning can refer to diverse situations.

In the broadest sense, weaning begins as soon as an infant starts consuming any foods in addition to breast milk. Thus, the two-week-old baby who is given a daily bottle of formula has already begun the weaning process. An exclusively breastfed infant may not start to wean until solids are introduced at six months of age. Babies who enjoy the full natural course of breastfeeding, extend-ing into the second or even third year, eventually spend more time weaning than breastfeeding exclusively.

Although weaning was meant to be a gradual process, sometimes abrupt termination of breastfeeding becomes necessary. This is especially difficult on mother and baby when an exclusively breastfed infant must be weaned suddenly.

Mother-Led Weaning In our society, weaning is commonly structured around the mother's plans and desires. For example, many American women wean their babies prior to returning to work because they doubt they can combine breastfeeding and employment. Women may commit to breastfeeding for an arbitrary length of time, such as six months, and then stop nursing when they reach their predetermined goal. Unfortunately, countless women who originally intended to nurse longer resign themselves to weaning early due to unresolved lactation difficulties that place a damper on their breastfeeding experience. Some women say they feel tied down by breastfeeding, especially when their babies refuse to accept nutrition by any other means. They may decide to wean in order to share responsibility for feedings with their partners. Other common mother-led reasons for weaning include to go on a strict weight-reduction diet, to resume alcohol consumption, to participate in certain athletic activities, or to go on a vacation with their partner. Probably the most frivolous explanation I've ever heard for early weaning was to be able to wear a particular gown to a formal affair!

Sometimes mother-led weaning occurs for more valid reasons. For example, I have known some older women who, having started their families late, decided to wean in order to increase their chances of conceiving another child. I also have encountered a number of women whose breastfed babies displayed severe allergic reactions to numerous foods in the mothers' diets. These dedicated women had restricted their own diets while breastfeeding, sometimes to a drastic degree. Once their babies were old enough to drink cow's milk, some of these women were anxious to wean in order to be able to eat a more varied diet.

A few women must wean their babies due to compelling health issues that leave them no choice. For example, a young mother with cystic fibrosis chose to wean her three-month-old infant because her lung function had deteriorated so rapidly while breastfeeding and she had lost excessive weight. In another heart-wrenching case, a woman was diagnosed with extensive breast cancer while exclusively breastfeeding her six-month-old baby. With her very survival at stake, the mother was forced to wean abruptly, much to her own and her baby's distress. Within a matter of days, she underwent a mastectomy and began a course of chemotherapy. I can't imagine the turmoil of emotions with which she must have wrestled as she reluctantly weaned her confused infant in the battle for her own health. Happily, this exceptional woman is alive and well, free of cancer, more than fifteen years later.

While most babies handle weaning without permanent trauma, sometimes a mother's decision to wean conflicts with a baby's health or emotional needs. I recall an infant with severe, chronic liver disease whose mother had managed to breastfeed her through multiple hospitalizations. After many months of nursing and providing specialized care for an extremely ill infant, the weary mother expressed her desire to wean. While I applauded this woman's remarkable efforts to that point and empathized with her wish for more control over her life, my compassion for her critically ill little girl was even greater. Breastfeeding clearly served as the principal source of consolation and pacification for this unfortunate, and often miserable, baby. Her tired mother wistfully imagined that weaning would bring respite from the near-constant care required by her chronically ill infant. In actuality, it was more probable that the sudden withdrawal of this child's emotional anchor would create more problems than it would solve. After a candid discussion, we attempted to balance the needs of both parties by validating the mother's weariness, providing her with regular breaks and sufficient opportunity to attend to her own needs, while allowing her sick infant to continue to nurse. Whether the decision is based on a trivial want or a pressing need, the fact is that mothers often determine when breastfeeding stops. As a family advocate, I view my principal role in this matter as providing accurate information to enable parents to make the best possible decision given their unique circumstances. Then I commit to supporting parents, especially mothers, in the achievement of their goals. I know many well-meaning breastfeeding advocates whose mission is to prolong the duration of breastfeeding at any cost. However, coercing mothers to nurse or inflicting guilt when they decline to breastfeed does not serve families well. Many of the reasons for weaning that I cited above might be considered invalid by you or me. But I believe we must honor, and not judge, another woman's decision based on her circumstances and values. Whenever weaning occurs and whatever the reason, I believe emphasis should be given to validating the breastfeeding that was accomplished, rather than focusing on the breastfeeding that might have been.

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